Conventional high heeled footwear is often uncomfortable, tiring, and even painful to wear and to walk in. There are several medical problems associated with wearing high heels, including foot, ankle, knee, hip, and lower back problems. Yet many women still wear high-heeled footwear regularly because it can make the wearer more stylish, elegant, professional, and/or sexy, and to make the wearer look taller. Some men also wear such high-heeled footwear, for example in certain oriental cultures; also, high-heeled footwear is often worn by cross-dressing transvestite men.
The discomfort and pain from wearing high-heeled footwear arises because high-heeled footwear significantly alters the wearer's stance/posture and natural walking gait cycle. In flat shoes, the weight distribution is approximately 5% over the phalanges, 40% over the metatarsals, 5% over the midfoot, and 50% in the heel areas of the foot. Thus body weight is relatively evenly distributed between the front part and the rear part of the foot. High-heeled footwear alters the angle that the wearer's foot projects forwardly from the leg, so that the weight load of the body cannot be supported in the same way as the foot in a natural position. In a high heeled shoe with a two inch heel, 70% of the wearer's body weight is borne by the balls of the wearer's foot. As heel height increases, the percentage of body weight carried by the balls of the foot is increased. The raised heel causes disproportionate loading in the forefoot and slippage of the foot into the toe part when standing or walking. A substantial percentage of high-heeled shoe wearers report pain associated with the wearing of such footwear within one to four hours of typical walking, standing, and sitting found in a work or social environment. In many high-heeled shoes the steep ramp of the shoe causes the foot to slide downwardly, crowding and cramping the toes. Without a doubt, high-heeled shoes are uncomfortable to stand in or walk in for long periods of time.
Foot problems from wearing high heeled shoes also arise because regular use of high heels causes calf muscles and tendons to shorten relative to their normal length without shoes. The higher the heel height, the more contracted the calf muscles will become over time. At first, the symptoms include a temporary effect in which the calf muscles can still be stretched out after wearing high heels all day. Eventually, a permanent shortening of the muscles and tendons occurs. Once shortened there is a risk that the Achilles tendons can tear if the calf muscles and Achilles tendons are stretched beyond their new shorter length. Ironically, there are many women who cannot wear flat shoes because of this problem, and the pain associated with it. To avoid this problem a woman must remember to stretch the muscles and tendons after wearing high heels.
Normal walking involves at each step a “heel strike” when the heel comes in contact with the ground, a “roll” from the heel through the ball of the foot, and then lifting the ball of the foot from the ground at the “toe off.” Heel contact at the heel strike is more abrupt when wearing high heels, causing the wearer to slam her body weight onto the balls of the feet to complete the roll, thus subjecting the ball of the foot to abnormal pressure levels. With greater impact and higher dynamic loads at the heels and metatarsals due to raised heels, the natural shock absorbers of the foot do not provide sufficient protection, resulting in various degenerative changes and injury.